Global Spike of Cholera Cases Amidst Vaccine Shortage Prompts WHO to Recommend Single Dose Instead of Two
A health worker monitors a cholera vaccination campaign in Sinnar, Sudan.

With more cholera outbreaks overstretching the world’s limited vaccine supply, WHO recommends temporarily suspending the standard two-dose regimen to vaccinate more people. Meanwhile, Africa aims to re-energize its COVID-19 vaccine rollout, despite steady decline in public turnout for vaccination. 

A shortage in the global supply of cholera vaccines has forced the World Health Organization to recommend that countries administer only a single vaccine dose – rather than the standard two doses to groups at risk, in order to conserve desperately-needed supplies. 

“The pivot in strategy will allow for the doses to be used in more countries, at a time of unprecedented rise in cholera outbreaks worldwide,” WHO stated in a news release just ahead of a briefing by WHO Africa Region officials Thursday on the regional situation, one of the regions seeing a sharp rise in cholera cases.

Globally, this year, a total of 29 countries have reported cholera cases to WHO. In Haiti, Malawi, Somalia and Syria, large outbreaks of cholera are currently underway, while the Democratic Republic of Congo, South Sudan, and Cameroon are among the other hotspots. In contrast, in the previous five years, fewer than 20 countries worldwide, on average, reported outbreaks.

The global trend is towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks, experts say.

“Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive and reactive campaigns,” reported WHO.  “And an additional 8 million doses were approved by the ICG for the second round for emergency vaccination in 4 countries, illustrating the dire shortage of the vaccine. As vaccine manufactures are producing at their maximum current capacity, there is no short-term solution to increase production. The temporary suspension of the two-dose strategy will allow the remaining doses to be redirected for any needs for the rest of the year.

“This is a short-term solution but to ease the problem in the longer term, urgent action is needed to increase global vaccine production,” WHO concluded.

Recommendation made by group  managing emergency vaccine supplies

Dr Phionah Atuhebwe, Vaccines Medical Officer, WHO African Region

WHO said the recommendation was initially made by its the International Coordinating Group (ICG) expert group, which manages emergency supplies of vaccines.

Defending its decision, ICG said the one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children.  

With a two-dose regimen, when the second dose is administered within 6 months of the first, immunity against infection lasts for 3 years,” it said.

Addressing the WHO AFRO briefing, Dr Phionah Atuhebwe, Vaccines Introduction Medical Officer said the temporary use of the one dose strategy will allow more people to be vaccinated and provide them with protection in the near term. 

“So it means we get more doses for DRC and Cameroon. However, while vaccines are still a critical tool in the prevention of these cholera outbreaks, they’re not the only tool we have. Cholera can be prevented with access to safe water and sanitation and also treated with oral rehydration or antibiotics for severe cases,” she said.

An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from the disease, according to the US Centers for Disease Control.

Africa has administered 70% of the 1 billion doses of COVID-19 vaccine received

Matshidiso Moeti, WHO African Regional Director

Since COVID-19 vaccination began in Africa, the continent has now received more than one billion doses of vaccines out of which it has administered over 70%, according to Africa CDC. Despite this milestone, Matshidiso Moeti, WHO Regional Director for Africa, told Health Policy Watch that Africa is far from the global goal set by WHO for vaccinating 70% of its population. 

In fact, only 8 countries in Africa have vaccinated more than half of their populations, Aurelia Nguyen, Gavi Special Adviser, told Health Policy Watch.

Moreover, COVID-19 vaccination coverage has stagnated in half of African countries, as the number of doses administered monthly declined by over 50% between July and September. Despite this, the continent has made modest progress in vaccinating high-risk population groups, including health workers and the elderly, the officials stated.

“I think it’s clear that we are far from the original targets that have been set as far as coverage with COVID-19 vaccination in the African region is concerned. At a certain point in time early this year, we were saying we need to ramp up seven times the rate at which vaccination was happening in the African region,” Moeti said.

Aurelia Nguyen, Special Adviser, Gavi, the Vaccine Alliance.

While COVID-19 vaccination coverage in Africa is way below global averages, booster coverage is even lower, Nguyen said.

“Programs that address these [issues] will really be where we’re going to save the most lives. And it’s also going to be the part that helps protect the health system overall, as we respond to the pandemic and other diseases,” she said.

Image Credits: Twitter: @WHOSudan, European Centers for Disease Control , Adepoju/Health Policy Watch .

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